The Impact of the Covid-19 Pandemic Restrictions on the Provision of Achd Care across Canada

Background: Patients with adult congenital heart disease (ACHD) are at increased risk for poor outcomes when compared to the age matched non-ACHD population and require specialist care to optimize outcomes including well-being and survival. The COVID-19 pandemic significantly impacted healthcare provision across Canada with reduction on in person evaluations. The effect of the COVID-19 restrictions on ACHD care including clinic evaluation, diagnostic and procedures in Canada has not been well characterized. Methods and Results: All Canadian Adult Congenital Heart Network affiliated ACHD centers were contacted and asked to collect data on outpatient clinic and procedural volumes for the 2019 and 2020 calendar years. A survey was sent to each site detailing questions on clinic and procedural volumes and wait times pre and post pandemic restrictions. Descriptive statistics were used with student t test to compare groups. Pre-pandemic (2019) there were 19326 ACHD clinic visits across Canada with 296 (1.5%) being virtual. During the first year of the pandemic (2020) there were a similar number of total clinic visits 20532, however 11412 (56%) visits were virtual p< 0.0001. Total procedural volumes for ACHD care are presented in figure 1. Pre-pandemic mean estimated clinic waiting times (in months) for non-urgent consults were: 5.4 + 2.57 vs. pandemic wait time 6.5 + 4.22, p=0.65, for elective ACHD cardiac surgery 6.0 + 3.46 vs.7.3 + 4.59, p=0.47, for ACHD electrophysiology procedures 6.3 + 3.33 vs 6.7 + 3.27 p=0.72, for ACHD percutaneous intervention 4.6 + 3.89 vs 4.4 + 2.33 p=0.74. Conclusion(s): During the pandemic, despite social distancing restrictions, the use of virtual clinics visits have helped to maintain continuity in ACHD clinical care. The procedural volumes and wait times for consultation, percutaneous and surgical interventions were not delayed. [Formula presented] Copyright © 2022

Trauma 101: A virtual case-based trauma conference as an adjunct to medical education

Background: The COVID-19 pandemic has substantially affected medical school curriculum, limiting access to simulationbased trauma education and core surgical clerkship rotations. Virtual learning has been integrated into medical education as an alternative to live synchronous sessions. However, its effectiveness for teaching critical concepts in trauma resuscitation has not been validated. Moreover, while small-group sessions are an effective pedagogical model in-person, less is known about how they translate to online learning in clerkship. Method(s): Medical students were invited to attend a 2-day virtual trauma conference organized by student interest groups at McMaster University and promoted on social media. The event included 9 interactive presentations by physicians and residents in 5 specialties, followed by virtual small-group case discussions. A best-match algorithm assigned students to their preferred small-group sessions. Participants completed anonymous pre- and post-conference trauma knowledge tests and feedback questionnaires. Results were analyzed using paired t tests and descriptive content analysis. Result(s): A total of 360 students from over 17 medical schools in 5 countries registered to attend the conference. There was a peak of 167 simultaneous connections during presentations and 68 participants during small-group discussions. A total of 131 students (36%) completed the pretest, with a mean baseline score of 3.4 out of 10 (standard deviation [SD] 2.04). Eighty-six students (24%) completed the posttest, with a mean score of 6.3 out of 10 (SD 2.3, p < 0.001). Among students who completed both preand post-tests (20%, n = 73), paired t test analysis reveals a substantial improvement of the mean score of 2.7 out of 10 (SD 2.3, 95% confidence interval 2.17-3.23, p < 0.001). There were no significant correlations between years of education and school attended with pretest performance. Social media enhanced group engagement, resulting in a total of 147 posts, whereby 37.4% were participant generated. Live polling and a moderated chat box improved participation during presentations, with 74% of participants agreeing that the didactic sessions were interactive. The conference was well received. Overall, 95.2% of participants agreed that the online platform was effective and 78.3% agreed that the conference was helpful preparation for clerkship. The response rate for feedback forms for the small group sessions was 58.8% (40/68). Preliminary descriptive analysis revealed 42.5% (17/40) of participants reflected favourably on group interaction during small-group sessions. Overall, 92.7% of the participants rated the small-group discussions as effective. Conclusion(s): With high participant satisfaction and significantly improved posttest results, this virtual model for trauma education at the medical student level is an effective adjunct to the clerkship curriculum. Virtual small-group case-based discussions and social media were beneficial in enhancing participant engagement. This study has important implications for the future design and implementation of international virtual conferences..

'Hypercycle' Learning System Based on 'Extension Classroom': Take Online Music Teaching During the COVID-19 Pandemic As An Example

The purpose of this paper is to provide an information interactive platform of teaching and learning, for self-learning diagnosis. We expand classroom teaching into an open teaching system consisting of 'before class' (online), 'in class' (online or offline) and 'after class' (online), which is called 'extension classroom'. This paper uses the method of complex system analysis to evaluate the students' learning state in 'before class' and 'after class' and concludes that the key to effective teaching and learning is that teachers clearly know how to teach and students know how to learn. This kind of teaching mechanism is realized in 'extension classroom' with supercycle. We applied the 'extension classroom' to the teaching of music performance during the COVID-19 pandemic, and the results showed that 65% of students improved their self-diagnosis ability, 46% had satisfactory communication with teachers, and 20% had a significant increase in learning performance. © 2021 IEEE.

Adjusting D-dimer to lung disease extent to exclude pulmonary embolism in COVID-19 patients (Co-LEAD)

Background : D-dimer is a safe tool to exclude pulmonary embolism (PE) but its specificity is decreased in COVID-19. Aims : Our aim was to derive a new algorithm with D-dimer threshold adjusted to CT extent of lung damage. Methods : We conducted a multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to CT extent of lung damage was derived in a patient set ( n = 337), and its safety assessed in an independent validation set ( n = 337). Results : According to ROC curves, D-dimer safely excluded PE, with one false negative when using a 900 ng/mL threshold when lung damage extent was <50% and 1700 ng/mL when lung damage extent was ≥50%. In the derivation set, the algorithm's sensitivity was 98.2% (95% CI: 94.7-100.0), and its specificity 28.4% (95% CI: 24.1-32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01-0.44) and the AUC was 0.63 (95% CI: 0.60-0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7-99.6) and 39.2% (95% CI: 32.2-46.1), respectively. The NLR was 0.08 (95% CI: 0.02-0.33), and the AUC did not differ from that of the derivation set (0.68 (95% CI: 0.64-0.72), P = 0.097). Using the Co-LEAD algorithm, 76/250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA). Conclusions : The Co-LEAD algorithm safely excludes PE, and allows reducing the use of CTPA in COVID-19 patients. Prospective management studies are necessary to validate this strategy.